Objective To study operative treatment of severe tibial pilon fracture.Methods Between March 2010 and September 2016,29 patients with severe pilon fracture received operative treatment and complete follow-up at Department of Orthopaedic Surgery,Maternal and Child Care Service Centre of Guangzhou Nansha District.They were 24 men and 5 women,aged from 23 to 62 years (average,40.3 years).According to AO/OTA classification,9 cases were type C1,12 type C2 and 8 type C3.There were 6 open and 23 closed fractures.Of them,27 were complicated with fibular fracture.Open reduction and intenal fixation was conducted in 22 cases and limited internal fixation combined with external fixation in 7.Results This cohort was followed up for an average of 15 months (from 12 to 25 mouths).All the fractures obtained union after an average of 16 weeks (from 8 to 28 weeks),but the union in 5 cases was delayed.According to American Orthopaedic Foot and Ankle Society (AOFAS) criteria for ankle and hind foot,16 cases were rated as excellent,9 as good,3 as fair,one as poor,yielding an excellent to good rate of 86.2％.The main complications included superficial necrosis of wound skin in 3 cases,which were cured by skin flap repair after wound treatment,and superficial and deep infection both in 2 cases,which were cured by dressing change.Conclusions Severe tibial pilon fractures should be treated according to their different types and severities of soft tissue injury,using different operative methods and timing.